2013 Volume 20 Issue 1 Pages 52-55
We report a patient with traumatic intracranial hypotension who needed epidural blood patches at three spinal levels. A 44-year-old man developed orthostatic headache the next day after he received a massage to the neck and higher back. The magnetic resonance images (MRI) of the head and neck, MRI myelography, radionuclide cisternography, and low pressure of the cerebrospinal fluid (CSF) indicated that he had traumatic intracranial hypotension. Intravenous hydration and bed rest failed to lessen the headache. An epidural patch with 13 ml of autologous blood was done via the C7/T1 interspace. The headache persisted. The MRI and MRI-myelography indicated the presence of CSF in the lower thoracic to the upper lumbar epidural space. The second epidural patch with 16 ml of autologous blood was performed via the L3/4 interspace; however, the headache remained. The third epidural patch with 12 ml of autologous blood via the T9/10 interspace was done. The headache disappeared two hours after the procedure.
